10 Benzodiazepine Overdose
Table of Contents
10.1 Overdose: Benzodiazepines Alone. 1
10.2 Overdose: Benzodiazepines + Opioids. 2
10.3 Benzo-Opioid Overdose Prevention. 4
National Institute of Drug Abuse: Overdose Death Rates
10.1 Overdose: Benzodiazepines Alone |
[No authors listed] CDC Vital signs: overdoses of prescription opioid pain relievers and other drugs among women – United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2013;62(26):537-42. Article
Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996 – 2013. Am J Pub Health. 2016;106(4):686-8. Article
Darke S, Torok M, Duflou J. Circumstances and toxicology of sudden or unnatural deaths involving alprazolam. Drug Alcohol Depend. 2014;138:61-6. Abstract
Isbister GK, O’Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol. 2004;58(1):88-95. Abstract
Lee D, Delcher C, Maldonado-Molina MM, et al. Manners of death in drug-related fatalities in Florida. J Forensic Sci. 2016;61(3):735-42. Abstract
Longo LP, Johnson B. Addiction: Part I. Benzodiazepines – side effects, abuse risk and alternatives. Am Fam Physician. 2000;61(7):2121-8. Article
Shah NA, Abate MA, Smith MJ, et al. Characteristics of alprazolam-related deaths compiled by a centralized state medical examiner. Am J Addict. 2012;21 Suppl 1:S27-34. Abstract
Toblin RL, Paulozzi LJ, Logan JE, et al. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J Clin Psychiatry. 2010;71(4):491-6. Abstract
Vukcević NP, Ercegović GV, Segrt Z, et al. Benzodiazepine poisoning in elderly. Vojnosanit Pregl. 2016;73(3):234-8. Abstract
Warner M, Trinidad JP, Bastian BA, et al. Drugs most frequently involved in drug overdose deaths: United States, 2010-2014. Natl Vital Stat Rep. 2016;65(10):1-15. Article
Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ. 2014;348:g1996. Article
Windfuhr K, Turnbull P, While D, et al. The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales. J Psychopharmacol. 2011;25(11):1533-42. Abstract
Zhang D, Zhang J, Zuo Z, Liao L. A retrospective analysis of data from toxic substance-related cases in Northeast China (Heilongjiang) between 2000 and 2010. Forensic Sci Int. 2013;231(1-3):172-7. Abstract
10.2 Overdose: Benzodiazepines + Opioids |
Bair MJ, Bohnert AS. Overdoses in patients on opioids: risks Associated with mental health conditions and their treatment. J Gen Intern Med. 2015;30(8):1051-3. Article
Brands B, Blake J, Marsh DC, et al. The impact of benzodiazepine use on methadone maintenance treatment outcomes. J Addict Dis. 2008;27(3):37-48. Abstract
Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths Involving opioid analgesics: United States, 1999-2011. NCHS Data Brief. 2014;(166):1-8. Article
Dasgupta N, Funk MJ, Proescholdbell S, et al. Cohort study of the impact of high-dose opioid analgesics on overdose mortality. Pain Med. 2016;17(1):85-98. Abstract
Delaveris GJ, Teige B, Rogde S. Non-natural manners of death among users of illicit drugs: substance findings. Forensic Sci Int. 2014;238:16-21. Abstract
Ekström MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014;348:g445. Article
Green TC, Grau LE, Carver HW, et al. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997-2007. Drug Alcohol Depend. 2011;115(3):221-8. Article
Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014;27(1):5-16. Abstract
Jones CM, McAninch JK. Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines. Am J Prev Med. 2015;49(4):493-501. Abstract
Jones CM, Paulozzi LJ, Mack KA, et al. Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths – United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(40):881-5. Abstract
Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657-9. Link
Lee SC, Klein-Schwartz W, Doyon S, Welsh C. Comparison of toxicity associated with nonmedical use of benzodiazepines with buprenorphine or methadone. Drug Alcohol Depend. 2014;138:118-23. Abstract
Liang Y, Goros MW, Turner BJ. Drug overdose: differing risk models for women and men among opioid users with non-cancer pain. Pain Med. 2016;17(12):2268-2279. Abstract
Lintzeris N, Nielsen S. Benzodiazepines, methadone and buprenorphine: interactions and clinical management. Am J Addict. 2010;19(1):59-72. Abstract
Parhami I, Massey J, Trimzi I, et al. Risks associated with co-prescribing opioids and benzodiazepines and Delaware’s Prescription Drug Monitoring Program. Del Med J. 2015;87(9):270-4. Link
Park TW, Saitz R, Ganoczy D, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ. 2015;350:h2698. Article
Paulozzi LJ, Kilbourne EM, Shah NG, et al. A history of being prescribed controlled substances and risk of drug overdose death. Pain Med. 2012.13(1):87-95. Article
Paulozzi LJ. Prescription drug overdoses: a review. J Safety Res. 2012;43(4):283-9. Abstract
Paulozzi LJ, Logan JE, Hall AJ, et al. A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction. 2009;104(9):1541-8. Abstract
Siegler A, Tuazon E, Bradley O’Brien D, Paone D. Unintentional opioid overdose deaths in New York City, 2005-2010: place-based approach to reduce risk. Int J Drug Policy. 2014;25(3):569-74. Abstract
Sun EC, Dixit A, Humphreys K et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760. Article
Turner BJ, Liang Y. Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and / or sedative-hypnotics: interactions with mental health disorders. J Gen Intern Med. 2015;30(8):1081-96. Article
Walton GR, Hayashi K, Bach P, et al. The impact of benzodiazepine use on mortality among polysubstance users in Vancouver, Canada. Public Health Rep. 2016;131(3):491-9. Abstract
Webster LR, Cochella S, Dasgupta N, et al. An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Med. 2011;12 Suppl 2:S26-35. Article
Weisberg DF, Gordon KS, Barry DT, et al. Long-term prescription of opioids and/or benzodiazepines and mortality among HIV-infected and uninfected patients. J Acquir Immune Defic Syndr. 2015;69(2):223-33. Article
Zedler B, Xie L, Wang L, et al. Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients. Pain Med. 2014;15(11):1911-29. Abstract
10.3 Benzo-Opioid Overdose Prevention |
Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115-30. Article
World Health Organization 2014 Community Management of Opioid Overdose
Benzodiazepine Antagonists
Ashton H. Benzodiazepine overdose: are specific antagonists useful? Br Med J. 1985;290:805-6. Article
Flumazenil
[No authors listed] Reversal of central benzodiazepine effects by flumazenil after conscious sedation produced by intravenous diazepam. The Flumazenil in Intravenous Conscious Sedation with Diazepam Multicenter Study Group I. Clin Ther. 1992;14(6):895-909. Abstract
[No authors listed] Reversal of central benzodiazepine effects by flumazenil after intravenous conscious sedation with diazepam and opioids: report of a double-blind multicenter study. The Flumazenil in Intravenous Conscious Sedation with Diazepam Multicenter Study Group II. Clin Ther. 1992;14(6):910-23. Abstract
[No authors listed] Reversal of the central effects of midazolam by intravenous flumazenil after general anesthesia and use of a long-acting opioid in hospitalized patients: report of a multicenter double-blind clinical study. The Flumazenil in General Anesthesia in Hospitalized Patients Study Group II. Clin Ther. 1992;14(6):939-53. Abstract
Dunton AW, Schwam E, Pitman V, et al. Flumazenil: US clinical pharmacology studies. Eur J Anaesthesiol Suppl. 1988;2:81-95. Abstract
Ngo AS, Anthony CR, Samuel M, et al. Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department? Resuscitation. 2007;74(1):27-37. Abstract
Penninga EI, Graudal N, Ladekarl MB, Jürgens G. Adverse events associated with flumazenil treatment for the management of suspected benzodiazepine intoxication – systematic review with meta-analyses of randomised trials. Basic Clin Pharmacol Toxicol. 2016;118(1):37-44. Abstract
Weinbroum AA, Flaishon R, Sorkine P, et al. A risk-benefit assessment of flumazenil in the management of benzodiazepine overdose. Drug Saf. 1997;17(3):181-96. Abstract
Williamson BH, Nolan PJ, Tribe AE, Thompson PJ. A placebo controlled study of flumazenil in bronchoscopic procedures. Br J Clin Pharmacol. 1997;43(1):77-83. Abstract
Guidelines – Policies
Gaither JR, Goulet JL, Becker WC, et al. The association between receipt of guideline – concordant long-term opioid therapy and all-cause mortality. J Gen Intern Med. 2016;31(5):492-501. Abstract
PDMP
Dormuth CR, Miller TA, Huang A, et al. Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines. CMAJ. 2012;184(16):E852-6. Article
Gomes T, Jurrlink D, Yao Z, et al. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ Open. 2014;2(4):E256-61. Article
Naloxone
Bell EF. The use of naloxone in the treatment of diazepam poisoning. J Pediatr. 1975;87:803-4. Link
Bell EF. Naloxone reversal of diazepam effects. Anesthesiology. 1980;53:264. Link
Jang DH, Tolchin B, Bruccoleri R, Nelson LS. Response to benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study. Hum Exp Toxicol. 2011;30:343. Link
Jordan C, Lehane JR, Jones JG. Respiratory depression following diazepam: reversal with high-dose naloxone . Anesthesiology 1980; 53: 293-8. Abstract
Malizia E, Cerbo R, Ambrosini M, et al. Naloxone treatment of acute alcoholic or benzodiazepine intoxication. J App Toxicol. 1982;2:39-41. Abstract
Puig Abulí M, Navarro MP, Pisa Borja J, et al. Use of naloxone in the treatment of clonazepam poisoning. An Esp Pediatr. 1981;14:145-7. Link
Solhi H, Mostafazadeh B, Vishteh HRK, et al. Benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study. Hum Exp Toxicol. 2011;30(7):535-40. Abstract
Yuan W, Williams BN. Use of naloxone in the treatment of benzodiazepine poisoning. Human and Experimental Toxicology. 2012; 31:406-7. Article
